Infographic and Commentary from Practice: Reasons and Pathways for Patients to Biological Treatment of Asthma
For asthma patients with the most severe forms of the disease to access targeted biological treatment, they must undergo examination at one of the specialized centers for severe asthma. To facilitate this pathway, a recommended procedure has been issued, from which we present a pragmatic extract for practice in the form of a clear infographic.
Asthma is today in most cases a “good diagnosis”. This “heretical designation” of the disease stems from the potential of today's treatment options. Unlike other diseases and conditions that cause shortness of breath (primarily left-sided heart failure in cardiovascular diseases, deconditioning /often associated with obesity/ and chronic obstructive pulmonary disease (COPD)), standard pharmacotherapy for asthma can gain full control, i.e., eliminate all problems and prevent adverse developments, in more than 95% of patients. This is achieved by a fundamentally simple treatment strategy, which is based on inhaled corticosteroids (ICS).
For the remaining group of nearly 5% of the most severe asthma patients, who until recently were condemned to the necessity of using systemic corticosteroid therapy (with all its side effects; and often even that was not enough!), new possibilities have been coming in recent years thanks to targeted biological treatment. This brings a fundamental turnaround in the otherwise unfavorable course of the disease even for these patients.
Thus, the biggest problem in treating asthma today “paradoxically” lies in two basically trivial circumstances:
- In the first group of patients, it is primarily poor adherence to preventative treatment and incorrect inhalation technique.
- In the second group, it is the fact that these patients do not reach biological treatment at all.
For asthmatic patients with the most severe forms of the disease to reach biological treatment, they must undergo examination at one of the specialized centers for severe asthma. To facilitate this pathway, a recommended procedure for referring patients to centers has been issued, published at the turn of 2022/23 in the core journals of allergists and pneumologists whose care encompasses the majority of difficult/severe asthma patients in the Czech Republic.
The pragmatic extract of this recommendation is clearly presented in the following illustrations; for more information, we refer you to the websites of the Czech Pneumological and Phthisiological Society, CLS JEP CPFS, and the Czech Society of Allergology and Clinical Immunology, CLS JEP (CSAKI) or directly to the website www.tezke-astma.cz.
doc. MUDr. Milan Teřl, Ph.D.
Clinic of Pneumology and Phthisiology, Charles University Faculty of Medicine and University Hospital Pilsen
Literature:
1. Agache I., Akdis C., Akdis M. et al. EAACI Biologicals Guidelines – recommendations for severe asthma. Allergy 2021; 76 (1): 14–44, doi: 10.1111/all.14425.
2. GINA. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma, 2020. Available at: www.ginasthma.org
3. Kašák V., Kašáková E. Inhalation systems in the treatment of diseases with bronchial obstruction. Maxdorf, Prague, 2017.
4. Krčmová I., Novosad J., Sedlák V. Biological treatment in severe asthma. Postgraduate Medicine 2019; 21 (4): 354–364.
5. Teřl M. Asthma bronchiale in the context of internal medicine. Internal Medicine 2017; 63 (11): 757–769.
6. Teřl M. Biological treatment of asthma. Acta Medicinae 2021; 10: 8–11.
7. Teřl M, Sedlák V, Krčmová I. Recommended procedure for diagnosis and treatment of severe asthma. Stud Pneumol Phthiseol 2022; 82 (4): 122–127; Allergies 2023; 1: 25–30.
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